HomeMy WebLinkAboutBLD2007-00326 • S
MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Fort Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD07-00326 Received Date: 6/18/2007
SITE ADDRESS: `a.`ik W )uteS !?y \►fIC i-ec)(
Issue Date: 7/20/2007
GARDINER, 98382
APPLICANT: GAB INC
A CALIFORNIA CORPORATION
9909 TOPANGA CANYON BLVD
CHATSWORTH CA 913113602
SUBDIVISION: Block: Lot: T33
PARCEL#: 002331027 Section: 33 Township: 30 N Range: 02 W
CONTRACTOR/ SITE SERVICES LLC PHONE: 360-542-8301
DEALER 1500 E COLLEGE WAY STE A-289
MT VERNON WA 98373
360-854-0536
Contractor's License SITESSL945CZ Expires 2/9/2008
PROJECT DESCRIPTION: NEW MAN HOME -SKYLINE MODEL 1252
MAKE: SKYLINE
YEAR: 2007
SIZE: 70 X 27
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 7/20/2008.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): t ( - t.3, J
Stormwater FINAL Approval: GL-r-, pS 4 �ifu1ucpbu-r5 OK 'Mgj i
Blocking/Plumbing: 94._ It- (3 ' 27
Propane Tank/Lines /01
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps: t
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSP C N
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT-LINE AVAILAB_E 24 HOURS A DAY
SPECIAL CONDITIONS APPLY- SEE REVERSE
•
I•
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD07-00326
SITE ADDRESS: 241 HAWKS PRAIRIE RD Issue Date: 07/20/2007
GARDINER, 98382 Final Date: 1/31/2008
APPLICANT: GAB INC PHONE: 360-301-3009
A CALIFORNIA CORPORATION
9909 TOPANGA CANYON BLVD
CHATSWORTH CA 913113602
SUBDIVISION: Block: Lot: T33
PARCEL NUMBER: 002331027 Section: 33 Township: 30 N Range: 02 W
PROJECT DESCRIPTION: NEW MAN HOME - SKYLINIE MODEL 1252
SERIAL NO. 2F91-0265-WBA
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003
EDITION.
OCCUPANCY GROUP: •
b` \ 1H-- 0cc
TYPE OF CONSTRUCTION: n_,p2 C C — J LA '-
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 1/31/2008
I:\F_BLD_Occupancy.rpt 10/29/19
BUILDING PERMIT APPLICOOION ML ReviewTy 339
Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00326 Received Date: 6/18/2007
SITE ADDRESS: GARDINER BEACH RD
OWNER: GAB INC PHONE: 360-301-3009
A CALIFORNIA CORPORATION
9909 TOPANGA CANYON BLVD
CHATSWORTH CA 913113602
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002331027 Section: 33 Township: 30 N Range: 02 W
CONTRACTOR: S t 54.3( J -` Le-) — PHONE:
PHONE:
REPRESENTATIVE: Lir‘AG� jc,..' x Ca PHONE3L0 '(O L • izOT1
PROJECT DESCRIPTIOP NEW MAN HOME - SKYLINE MODEL 1252
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date: / J / 9/o 1
Type Amount Paid By: Date: Receipt: Approved/Date
Manufactured Homes $163.00 CJZ 06/18/07 91183
Potable Water Application $58.00 CJZ 06/18/07 91183 APPROVE D
Total: $221.00
JUL old 2007
Jefferson County Planning
& Building Department
•SPECIAL CONDITIONS CASE # BLD07-00326 •
1.) PRIOR TO OCCUPANCY& BUILDING FINAL INSPECTION FINAL APPROVAL OF
SEPTIC SEP07-61 IS REQUIRED.
2.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS.
3.) The application was reviewed by the Jefferson County Department of Community
Development staff on July 20, 2007 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC).
After an initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
SARPA & SUSC aquifer recharge area.
4.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
6.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special
Aquifer Recharge Protection Areas and the following land uses located within Susceptible
Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural
Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All
Rural Residential Land Uses with nonconforming uses that would otherwise require a
Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential
Developments (6) Unsewered residential development with gross densities greater than
one unit per acre. All of the above listed uses shall be subject to the applicable
requirements and standards of the Jefferson County Unified Development Code.
7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
8.) The applicant is proposing to create or add 4986 square feet of impervious surface and
4986 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the
project applicant submit a stormwater plan meeting Minimum Requirements#1 through #5
of the Department of Ecology Stormwater Management Manual for Western Washington.
The stormwater plan shall address measures to control stormwater, erosion and sediment
during construction and shall address permanent measures to stabilize soil exposed
during construction, and in the design and operation of stormwater and drainage control
systems.
9.) A Stormwater Site Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
10.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i).
11.) The site plan as submitted with the manufactured home installation application on June
18, 2007 has been reviewed for consistency under the UDC, and has been approved by
Jefferson County Department of Community Development. Any modifications, changes,
and/or additions to the stamped, approved site plan dated July 20, 2007 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
12.) This approval is for a manufactured home installation application only. Any future permits
on this site are subject to review for consistency with applicable codes and ordinances
and does not preclude review and conditions which may be placed on future permits.
13.) The parcel has been designate, as RR 1:5 under the Jefferson County Correhensive
Land Use Map effective August 28, 1998.
14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
15.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened
from view of neighboring dwellings and rights-of-way. Such screening shall meet all
applicable performance and development standards specific to the district in which the
storage is kept, and shall be in keeping with the character of the area. Screening shall
meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an autormobile wrecking
yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
16.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
17.) The building height is not to exceed 35 feet.
18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
19.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
20.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
21.) Minimum setback from the private ingress/egress easement right-of-way shall be 20 feet.
Minimum side and rear yard setbacks shall be 5 feet.
22.) The applicant will need to name the road through the Public Works Department and have
a 911 number assigned prior to final building occupancy.
23.) The site is served by Gardiner LUD#1.
24.) A septic permit(SEP07-0061)was approved on May 7, 2007.
25.) THE PROPONENT IS REQUIRED TO NAME THE ROAD THROUGH THE PUBLIC
WORKS DEPARTMENT SO A 911 NUMBER CAN BE ISSUED FOR THE PARCEL.
NO FINAL OCCUPANCY SHALL BE GRANTED BY JEFFERSON COUNTY UNTIL
SUCH TIME THAT THE ROAD HAS BEEN NAMED AND ACCEPTED BY THE COUNTY
AND A 911 NUMBER ASSIGNED.
ry ��, JEFFE N COUNTY •
4w S�, DEPARTMENT OF COMMUNITY DEVELOPMENT �- \ _._______�_�`—
'' '� 621 Sheridan Street • Port Townsend ..Washington 98368 i �r ' ��
360/379-4450 • 360/379-4451 Fax _ '
p www.co.jefferson.wa.us/commdevelopment ` t-•;
1`S$IN 0 •
019 µ
Master Permit Application IyILA• '
Project Description(include separate sheets as necessary):
Single Family Manufactured Home
Tax Parcel 002331027 Property '• 5.R 0
Number: Size: •2.90-.'1ores (acres/square feet)
Site Address and/or Directions to Property: XXXX Gardiner Beach Road, Sequim, WA 98382
Property Owner(s)of Record: GAB INC Garrett Bandy
Telephone:360-301-3009 Fax: email:
Mailing Address: 950Gardiner Beach Road,Sequim,Wa 98382
Applicant/Agent(if different from owner): Cindie Pruiett,Site Services,LLC
Telephone: 360-542-8301 Fax: 360-854-0536 email: cindie@siteserviceslic.us
Mailing Address: 1500 E College Way,Suite A-289,Mount Vernon,WA 98273
What kind of e'-^^'•''''heck each box that applies
(Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑Conditional Use[C(a), C(d),or C]**
17 Single Family ❑Garage Attached/Detached C]Discretionary"D"or Unnamed Use Classification
u] Manufactured Home El Modular C]Special Use(Essential Public Facilities)**
❑ Commercial* C]Boundary Line Adjustment
❑ Change of Use C]Short Plat**
❑ Address ❑ Road Approach C]Binding Site Plan**
❑Home Business El Cottagelndustry El Long Plat**
❑Propane El Planned Rural Residential Development(PRRD)/Amendments**
❑Sign El Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis Cl Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management El Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* El Shoreline Management Variance
❑Temporary Use Cl Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* Cl Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium El Tree Vegetaion Request
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate Cindie Pruiett,Site Services,LLC o2 to act as my agent in matters relating to:is a plic tion for permit(s).
i si r'J A Or uf&re c�
OWNER SIGNATURE t., Date: G� O.
By signing this application form,the owner gent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant info s the County in writing at the
time of the applic 'o hat r e wants prior notice.
Signature: Date: C ri 07
The action or actions Applicant wil undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in com fiance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfers n " i' or adhering to and complying with the ESA. The Applicant has read this disclai er of d signs and dates it below.
Signature: Date: ‘�7j1(�
C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OI.K86\Mast(r Permit Application 12-19-2006.doc
• •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
Site Services,LLC ( 360)542-8301 (360 )854-0536
MAILING ADDRESS: 1500 E College Way,Suite A-289 Mount Vernon,VVA 98273 EMAIL: 1500 E College Way,Suite A-289 Mount Vernon,WA 98273
CONTRACTOR'S LICENSE WAINS
NUMBER: SITESSL945CZ NUMBER WAINS1667
ARCHITECT/ENGINEER: PHONE
( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms.: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 2 Height: it Individual System
❑ Repair ❑ Masonry SEP Permit#SEP07-0061
❑ Demolition ElOther: Bedrooms: Water Supply:
Existing: Setback: I I Private well Two Party
Type of Heat: Proposed: ✓ Public
Electric Forced Air Total: 3 Name of System:PUD#1
at Jefferson County
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
❑Underground Tank °Above ground Tank Size of Propane Tank:
❑Heat Stove ❑Cook Stove 0 Woodstove ❑ Fireplace Insert ❑Hot Water Tank ❑Pellet Stove ❑Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: ��
1890
2°Floor Heated Consistency Review: 153
Other Heated Base fee: 1 (A9 3
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: 3
Garage/Carport SUBTOTAL
L t�
Decks 911/Rd Approach fee:
144
Other =
TOTAL: $
Receipt Number: ! l 1 8 3
1890 Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:•Fair market value of all labor and materials foundation to finish C2 //
� 07
Initials:
J U N 1 8 270?
C:\Documents and Settings\carat\Lcal Settings\Temporary Internet Files\OLK86\Master Permit Application 12:f9-2006.doc
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JACK WESTERMAN. Jefferson Courthouse
ASSESSOR PO Box Igplity
, Port Townsend,W,t 98368
(360)383-9I05
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS: •
NAME: N,e I I L►r i r'e 1- 3L-.c6ce.r-ci
ADDRESS: 2L t tIve,Ia nnc`_ e_(-i 14 4- Ser ;Y) , Lk)A 40 3‹9
PHONE NO. 3Cp0-- L og i 60077
The purpose of this questionnaire is to obtain information regatiffhao.,tither the
current location of a mobile home or the previous ownership andlocattrn of a mobile
home. This will help our office determine whether the mobile home is already ten the
tax rolls in Jefferson County or if it has been moved to this county from ano#ter area.
l)MOBILE HOME DATA:
(A) MAKE 8e p (B) MODEL I z5L- (C)YEAR o26Y>7
(D) LENGTH 7L r (E) WIDTH Z 7 (F)SERIAL #
(G) YOUR PURCHASE PRICE (Do not include sales tax) i/) 7X.b° PURCHASE DATE II I01:2CY�c
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last yir.
30WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes 410
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PAR
NAME OF LAND OWNER: Gila ..D3c , ,ire tl atiati
LOCATION ADDRESS XXX gate-d,, Je'iz i3e. y,.� ,Ii)/9
REAL PROPERTY PARCEL #/DESCRIPTION DOD-33/0 a 7
ee4064'
� de."(L&
Signature of applicant
THANK YOU FOR YOUR HELP!
e_
JODI COSSELL, Property Technician
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ti DEPARTMENT OF COMMUNITY DEVELOPMENT I
44b1P\e'
, , 621 Sheridan Street • Port Townsend • Washington 98368 I
48, O 360/379-4450 • 360/379-4451 Fax '.t. ' ;, ��ti i
i7NO http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLANI SUBMITTAL TEMPLATE
MLA# PROJECT/APPLICAN--NAME:
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
U c.u_) S t�4.t F&r _L ` ILI5 �; I `85
Existing Conditions Summary
2. Describe the existing topography. Indicate cnntnirrs on the site map.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
4. Describe the existing soils. Indicate soil type on the site map.
`err( )Oa►,--...
5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
6. Describe any excess levels of noise generated by the proposed use or activity,
APPROVED
ma.) STORMWATER PLAN
Stormwater :Ai's JUL 2
Require' ili. i o.
Stormwater site plan template.doc—rev.10/12/2003 , . JEFFERS U
DFPT.Of 1 V t PME -
SIGNATURE:
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7. Describe significant geographic features and critical areas (i.e.. environmentally sensitive areas su,ch'as vlantls, streams;
steep slopes.etc.)on the site. Indicate location on the site map F i
lett ►) OP'f' ,Y\P ivAP .h r. Y
� P;AEN7
8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas
(streams,wetlands, lakes,steep slopes,etc.).
rLQSIa /al' a a o- , A.)EA 2.S T �tA:�1AS
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual)or, if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for"large"projects or projects that involve the potential for dispersion of contaminants.]
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11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system.
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material, physical characteristics of fi!I material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the pro osed surfacing material.
18. Describe methods for restoration of the site. /
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals
here.
20. List here and inclu any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)--
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the,applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent i resp>5'nsibleLZp/
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Storm ater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural tial
development. �NTY
i)EvEL.OPMENT J
SECTION I-CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements-Construction SWPPP
1. Mark Clearing Limits.
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2. Establish Construction Access.
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3. Control Flow Rates.
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4. Install Sediment Controls.
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5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets.
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12 Required Elements-Construction SWPPP(continued}
8. Stabilize Channels and Outlets. "__ 1
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9. Control Pollutants. i:• ('ri_OPF," NT j
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of 1 n.ar 13itg_ r 1
soils(e.g., erodibility, settleability, permeability,depth,texture,soil structure).
5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
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Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes, and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems, treatmerr facilities, flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
C ( DOWN AUTHORIZE RES TATIVE SIGNATU (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
.,I JUN 18 ,��i' 1'._.1
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